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    自身免疫性溶血性贫血合并淋巴瘤的临床特点及预后因素

    Clinical Characteristics and Prognostic Factors of Autoimmune Hemolytic Anemia-Related Lymphoma

      摘要
    • 摘要:
      目的 分析伴有自身免疫性溶血性贫血（autoimmune hemolytic anemia，AIHA）的淋巴瘤患者的临床特征，探讨治疗效果、预后影响因素及临床治疗方案。
      方法 收集2011年1月至2023年7月在徐州医科大学附属医院血液科治疗的18例淋巴瘤合并AIHA患者的临床资料，回顾性分析其临床特点、治疗效果及预后生存情况。
      结果 18例患者的中位发病年龄为61岁，其中男性12例，女性6例，Ann Arbor分期为Ⅱ期4例，Ⅲ期8例，Ⅳ期6例。根据免疫表型来源不同，T细胞淋巴瘤4例，B细胞淋巴瘤14例，其中弥漫大B细胞淋巴瘤10例。18例患者AIHA抗体类型皆为温抗体型，其中IgG型4例，补体C3型5例，IgG+补体C3型7例，2例患者类型未定。IgG水平对淋巴瘤患者是否合并AIHA有统计学意义（P=0.042）。国际预后评分（International Prognostic Index，IPI）高低对淋巴瘤患者是否合并AIHA有统计学意义（P=0.011）。利用受试者工作特征（receiver operating characteristic，ROC）曲线分析出乳酸脱氢酶（lactate dehydrogenase，LDH）最佳截断值为400 U/L（P=0.002）后，对其进行分组并利用Kaplan-Meier法进行生存分析发现：LDH>400 U/L是影响患者总生存（overall survival，OS）的不利预后因素。患者性别为女性是影响OS和无进展生存（progression-free survival，PFS）的不利预后因素。IPI评分为高中危/高危组（3~5分）是影响OS的不利预后因素。18例患者2年OS率为50%，2年PFS率为62.9%。
      结论 淋巴瘤合并AIHA临床较少见，好发于老年，多数为Ⅲ~Ⅳ期患者，治疗上应根据患者临床特征采取个性化的治疗方案，预后主要取决于淋巴瘤的缓解程度，患者总体预后较差。

       

      Abstract:
      Objective To analyze the clinical characteristics of lymphoma patients with autoimmune hemolytic anemia(AIHA), explore treatment efficacy, prognostic factors, and clinical treatment plans.
      Method Clinical data of 18 patients with lymphoma complicated with AIHA who were treated in the Hematology Department of Xuzhou Medical University Affiliated Hospital from January 2011 to July 2023 were collected, and their clinical characteristics, treatment effects, and prognosis survival were retrospectively analyzed.
      Result The median age of onset in 18 patients was 61 years old, including 12 males and 6 females. Ann Arbor staging included 4 cases in stage Ⅱ, 8 cases in stage Ⅲ, and 6 cases in stage Ⅳ. According to the different sources of immune phenotypes, there were 4 cases of T-cell lymphoma, 14 cases of B-cell lymphoma, among them 10 cases of diffuse large B-cell lymphoma. The AIHA antibody types of 18 patients were all warm antibody type, including 4 cases of IgG type, 5 cases of complement C3 type, and 7 cases of IgG + complement C3 type, and 2 patients was undetermined. The IgG level had statistical significance(P=0.042)in determining whether lymphoma patients have AIHA. The International Prognostic Index(IPI)score has statistical significance(P=0.011)in determining whether lymphoma patients have AIHA. After using the receiver operating characteristic (ROC) curve analysis, the optimal cutoff value for lactate dehydrogenase(LDH)was determined to be 400 U/L(P=0.002). After grouping them and conducting survival analysis using the Kaplan Meier method, it was found that LDH >400 U/L was an unfavorable prognostic factor affecting patient overall survival (OS). The gender of the patient being female was an unfavorable prognostic factor affecting OS and progression-free survival(PFS). The IPI score of high, medium, and high-risk groups(3~5 points)had a significant impact on OS. 18 patients had a 2-year OS of 50% and a 2-year PFS of 62.9%.
      Conclusions Lymphoma combined with AIHA is rare in clinical practice and is more common in the elderly, mostly in stage Ⅲ~Ⅳ patients. Personalized treatment plans should be adopted based on the clinical characteristics of patients, and the prognosis mainly depends on the degree of remission of lymphoma. The overall prognosis of patients is poor.

       

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